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The Right to Health in Uruguay

In 2007, the People’s Health Movement in Uruguay took a critical stance on the right to health and has been campaigning vigorously as part of the Global Campaign for the Right to Health.

Fernando Borgia shares the experience.

Uruguay is a small country, both geographically and in terms of population. Ninety per cent of people live in the capital and in the departmental capitals. There are however, small numbers in the countryside and people crowd around the horse changing posts and railroad stops. These populations, and also those that live on farms, comprise what we call “the deep inside” or “the real country”. There are few opportunities to receive information, exchange and discuss views on human rights topics, and to be heard. We decided to prioritise these populations in the ‘Right to Health Campaign’ in 2007 and linked up with the People’s Health Movement (PHM) globally.

A handful of volunteers from Montevideo held more than 80 briefings in over 60 locations in 19 departments to promote active participation in regional and national social health forums. We held preparatory meetings and regional forums, and shared these discussions at the 3rd Uruguayan Social Health Forum in 2007.

In Uruguay, we can say that we had a genuine dialogue about the right to health with more than 2,500 people. Lessons from Uruguay, from its people, and the problems and challenges they face, became a huge experience for us.

How useful was this mobilisation? Did it help us get closer to achieving the right to health? To answer these questions I should point out the context. Since March 2005, Uruguay has had a progressive government which recognizes health as a human right, and as a responsibility to be ensured by the State. This was a significant change from the previous government. When we held the forum in 2007, the law creating the National Integrated Health System (Sistema Nacional Integrado de Salud – SNIS) was still in debate; it was approved in December 2007. So, the forum was an area of discussion focusing on the health needs of people and their relationship with the health system. It showed the importance of social organisation in demanding rights, and the inter-relatedness of citizens and the health system.

Since the establishment of the SNIS we have continued to advocate for the right to health through our research project “The role of primary health care, community and rural clinics in the new SNIS”. The SNIS places special emphasis on primary health care, but as in many countries, the term “primary health care” has been used to describe multiple ways of operating the primary care level without a real development of primary health care in the original sense of the Alma Ata Declaration.

The creation of the ‘Movement of Users of Private and Public Health’ as a formal organisation in November 2007 was an important step. There are some particularly remarkable facts about this movement. It has members in all 19 departments of Uruguay. It has been recognised as an official task force by the national health authority. It has appointed one of its leaders to the National Board of Health, which is the highest health policy authority with citizen participation such as workers.

At the 4th Uruguayan Social Health Forum in Rio Negro (November-December 2008), we emphasised the importance and validity of the collaboration between different movements. Colleagues from the PHM in other parts of Latin America, such as Brazil also participated. PHM can be thought of as a common platform that unites various groups that make up the forum. In most of the groups, many people have endorsed on-line the People’s Charter for Health, the founding document of PHM.

The Social Health Forum is a space to connect national problems and experiences with the Latin American and global agenda for people’s health. It also acts as a chapter of the People’s Health Movement in Uruguay, and serves as a joint space of the Movement of Users of the Private and Public Health, ALAMES (the Latin American Association of Social Medicine), and the Uruguay Medical Union and, to a lesser extent, the Uruguayan Federation of Health (non-medical workers).

We have developed a training agenda for health activism. The most relevant result of the training activities has been to promote an alternative way of thinking in health. The representatives of the movement have modified their discourse, from demanding better health care services to demanding the right to health as a comprehensive vision including the social determinants of health. It is also important to note the growing relationship with trade unions, beyond the health sector, and various community organisations and NGOs interested in the right to health. Building a relationship with provincial governments has also been useful to ask for and to create opportunities for interaction with the Ministries of Health, Labor and Social Security, and Social Development.

Since 2004, we have been collaborating with other organisations in the preparation and presentation of the Annual Reports on Human Rights in Uruguay, especially in chapters concerning right to health, advances and setbacks in the country. This is the only independent systematic and collaborative report we have. In 2008 we edited jointly with Ideas-Action and Change (Ideas Acción y Cambio – IDAC, a social group from small town) a newspaper called ’People’s Graffiti’. We also have a blog, although it is not updated systematically.

When we linked up our national campaign with the People’s Health Movement, we found that many groups around the world are taking up the concept of the right to health, and using it as the standard for health systems and as a framework for making demands on their government and other duty bearers. We hope that by linking these local and national level groups together, we can help support them and build global awareness of the Right to Health.
Fernando Borgia